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How do you Appeal Prior Authorization Denials in Colorado?

13 Jul, 2025 Frank Ferreri

                               
Quick Hits

Thanks to Simply Research, we've covered prior authorizations and their denials in Colorado, but what happens when a prior authorization denial gets appealed?

Here's a look at the process in the Rocky Mountain State.

10-Day Rule

The requesting ATP shall have 10 days from the date of the written denial to submit an appeal with additional information to support the request.

The Payer shall have 10 days from the date of the appeal to issue a final decision and provide documentation of that decision to the Provider and parties.

Documentation

If the Payer is upholding a denial for medical reasons, the Payer shall have all the submitted documentation reviewed by a Provider.

Dispute Resolution

In the event of continued disagreement, the parties should follow dispute resolution and adjudication procedures available through the Division or the Office of Administrative Courts.

Expedited Hearings

An urgent need for Prior Authorization of health care services, as recommended in writing by an ATP, shall be deemed good cause for an expedited hearing.

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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